Rhytidectomy and Parotidectomy Combined in the Same Patient

Until now, aesthetic goals in parotid surgery have seldom been addressed because oncologic concerns have largely overshadowed aesthetic issues for patients with parotid masses. Fortunately, the majority of parotid masses are benign pleomorphic adenomas that rarely recur, leaving a large group of patients healthy after their parotid surgery, with some desiring aesthetic improvement in their facial appearance. Traditional parotidectomy incisions leave a visible scar on the neck as well as a visible hollow in the retromandibular region, which can extend onto the cheek. A rhytidectomy approach to the parotid gland allows for a more concealed, aesthetically appealing scar while maintaining good visibility and access to the parotid gland. By performing bilateral sub-SMAS (superficial musculoaponeurotic system) rhytidectomy after a parotidectomy, facial symmetry and balance is enhanced, and these aesthetic deformities can be minimized. The SMAS flap can help to fill the hollow and form a tissue barrier over the resected gland to prevent gustatory sweating. Finally, the incision scarring is minimized with a rhytidectomy-type approach. Two cases are reported in which patients underwent both rhytidectomy and parotidectomy. In the one case, the procedures were performed in the same surgical setting. In the other case, they were performed in a delayed fashion. These cases exemplify the possibility of addressing facial aesthetic goals of rejuvenation in a patient requiring parotid resection.     

Suprazygomatic SMAS in Rhytidectomy

A personal method for the treatment of the suprazygomatic SMAS and its results are presented. By acting on the suprazygomatic fibromuscular layer in the rhytidectomy, the surgeon can avoid tension on the cutaneous layer, and possible consequences thereof, as well as diminish the probabilities of damaging the facial nerve. At the same time, desired effects as a result of pulling on crow's feet, wrinkles, lateral eyebrows, and wrinkles on the lateral forehead are enhanced.     

Rhytidectomy: Suprazygomatic and infrazygomatic SMAS treatment

The soft tissues of the face and neck are firmer above the zygomatic arch than below it. The SMAS should be treated differently according to where it is situated with respect to this arch. Above the arch, both the skin and the S-SMAS are firmly attached making it possible to correct both simultaneously by means of a flap that includes both layers. Beneath the zygomatic arch correcting the I-SMAS by stretching and relocating it enhances the contour of the jaw and neck and gives greater support to the skin. This provides for even better conformation when excess subcutaneous tissue is resected. An intermediate region exists between the corrected areas of the S-SMAS and the I-SMAS where the rhytidoplasty is exclusively performed through traction and rotation of the skin, but added resources diminish traction sequels.     

鼻部表浅肌肉筋膜系统与隆鼻术假体层次关系的探讨

目的　明确鼻部表浅肌肉筋膜系统及隆鼻术假体置放层次与它们之间的关系。方法　运用显微解剖及组织学检查 18具成人尸体鼻部。结果　鼻部软组织分为皮肤、表浅脂肪、肌肉及其筋膜、深脂肪、骨膜及软骨膜五层 ,深脂肪层容易剥离形成腔隙。结论　隆鼻术硅胶假体置入层次为深脂肪层。鼻部表浅肌肉筋膜系统的解剖特点有助于假体的稳定。     

面部除皱术18例

总结面部除皱术１８例，对骨膜下除皱是否适用于东方人进行了讨论。认为东方人皮肤松弛的特点主要是因为年老，皮下脂肪减少，皮肤老化松弛而缺乏弹性，但皮下的肌肉系统与骨膜虽有松弛但往往很不明显，其皮肤的舒展度与肌肉骨膜系统的舒展度相差亦甚大。传统的额部除皱术，由于分离平面在帽状腱膜下，其额肌抵抗力影响了额部皱纹的舒展，就必须切除一块或三块额肌条和作部分皱眉肌及降眉肌切除，作者的手术实践也体会到，切除松弛皮肤３ｃｍ，ＳＭＡＳ仅能提紧２ｃｍ左右。如在骨膜下分离，由于受其舒展度限制，面部的肌肉系统又不能象额肌那样切除，切除的皮肤量就必然受到限制而影响除皱效果。作者仍主张分离平面在额部应选择在帽状腱膜下，颞区在颞浅筋膜上，面颊部在浅筋膜层。本文并对ＳＭＡＳ悬吊及术中有关注意事项也进行了讨论。     

Cervicofacial Rhytidectomy: The Superficial Plane

During the past 20 years, numerous techniques have been described to improve the results of facelifting as well as the duration of its rejuvenating effect. These increasingly aggressive techniques have increased the operating time, the potential morbidity of the operation, and the duration of convalescence. No one can ensure that this evolution in sophistication of rhytidectomy techniques give longer lasting results. Therefore, a simple technique applied under the appropriate indications gives good and predictable results.     

A Stratigraphic Approach to the Superficial Musculoaponeurotic System and Its Anatomic Correlation with the Superficial Fascia

The superficial musculoaponeurotic system (SMAS) is not included in the International Anatomic Terminology, although it is a fundamental anatomical structure in plastic surgeons. In the literature, the concept of the SMAS is not clear, leading to repercussions in the treatment of the SMAS via the various techniques for rhytidoplasty. This review article, in its aim to conceptualize the SMAS, has as a referential parameter the basic stratigraphic pattern of the human body construction. A systematic review of the literature was performed through Medline, ISI-Web of Science, and Lilacs databases as well as through classical treatises of anatomy for analyses of the stratigraphic principle of SMAS and its relationship to the fascia. In fact, SMAS, an anatomic entity, is part of this construction model. The stratigraphic approach followed in this article to describe the SMAS is novel in the literature and allows for a unified anatomic understanding of SMAS for the scientific community.